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Proper treatment of odontogenic myxoma
546
CURRENT LITERATURE
simulating bursae or angiomas with histiocytes and mucocytes to a dense, well-vascularized fibrous connective tissue pseudocyst. Inflammation is never conspicuous. Marsupialization inevitably leads to recurrence. Excision of the sublingual gland is required for effective managemerit.-G.H. SPERBER Reprint requests to Dr Batsakis: Division of Pathology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Houston, TX 77030. Rheologic Predictors of the Severity of the Painful Sickle Cell Crisis. Ballas SK, et al. Blood 72:1216, 1988 There is interest in defining hematologic factors that influence the clinical severity and frequency of sickle cell crisis. This article reports a study that examined the clinical, hematologic, and rheologic characteristics of erythrocytes in 65 patients and correlated the data with severity of sickling crisis. Patients who required parenteral nar-
cotic administration or hospitalization for sickling crisis were included in the study. Precrisis hematologic and rheologic data had been obtained on the patients during an asymptomatic state. Red cell deformability index (DI) and “denseness,” and counts of irreversibly sickled cells (ISC) were determined for precrisis and crisis states. Results disclosed that a high DI correlated positively with increased severity and frequency of crisis, whereas increased denseness and ISC correlated with a milder disease course. Increased erythrocyte deformability is theorized to enhance the stickiness of the cell to endothelium and result in capillary blockage. A more dense cell is more rigid, deforms less readily, and there is decreased surface contact with the endothelium and less respective adherence. The data suggest that patients with increased numbers of dense erythrocytes and ISC will have a lower DI and therefore less frequent sickling crises and a milder course of disease.-B.B. HORSWELL Reprint requests to Dr Ballas: Cardeza Foundation, 1015Walnut St, Philadelphia, PA 19107.
Continued from page 438 To the Editor:-1 read with interest, and some surprise, the letter of disappointment sent by Dr Michael S. Freedus. I was indeed fortunate that the AAOMS had taped the session. I was able to replay it and found that my recollections coincided with what was actually said. Unfortunately, neither my memory nor the tapes coincide with the statements or attitudes attributed to me by Dr Freedus. I did not “denounce arthroscopy entirely” or even partially. I did express my opinion on disc repositioning. I was not then and am not now “disgruntled” and I neither called for nor implied the need for a “moratorium.” I did not dispute the “successes reported,” but I did call for clear definitions of “success” and further called for objective supporting data. I do not recognize the procedure as “benign and effective,” but I am willing to accept scientific proof that it is. I have great difficulty dealing with such contradictory statements in Dr Freedus’ letter as “we’re learning” and that it is “erroneous (to) claim that it is ‘experimental’. ” I certainly agree that “we ourselves have been an influencing factor in recent third party refusal to pay for the procedure,” but not for the reasons implied by Dr Freedus. I stated quite clearly in my presentation where I felt the fault lay. It is my tendency to advance knowledge by questioning. I would, therefore, pose a question to Dr Freedus. If his practice is anything like mine, he probably sees few patients not previously treated. Since everybody claims enormously high success rates, regardless of the modality used, where are all these patients coming from? My only conclusion is that this same small patient population is being moved from office to office like the proverbially uneaten Christmas fruitcake.
DAVID I. BLAUSTEIN, DDS, PHD Chicago, Illinois PROPER TREATMENT OF ODONTOGENIC MYXOMA To the Editor:-1
R. Cuestas-Carnero
should like to comment on the article by et al on odontogenic myxoma (J Oral
Maxillofac Surg 46:705, 1988). This article has a number of flaws and inaccuracies. The authors state that myxoma not only does not respond well to radiation therapy, but a serious risk of malignant transformation exists if this method of treatment is used. However, despite this wise statement, they used radiation. Using radiation for the treatment of benign tumors is not well accepted by most surgeons, and its use in such instances is usually remembered only by regrets. Radiation for vascular tumors of the skull base is among the few exceptions; but, in the last few years, specialists in the field have opposed radiotherapy even in these cases. The authors use out-of-date references for supporting their use of radiation treatment. They cite Fletcher and Jesse’ and Attie et al* from reports published in 1962 and 1966, respectively, for providing “the rationale of the preoperative use of radiation” and quote the article of Busche and Galante from 19593 without reporting that both this and the former articles referred to malignant tumors only. My review of the pertinent literature indicates that surgery is the treatment of choice for odontogenic myxoma and that radiation for the treatment of benign tumors is contraindicated in most cases. A serious risk of malignant transformation of the primary tumor, as well as the development of secondary malignant tumors, exists when benign tumors in the head and neck region are irradiated. Y. ZOHAR, MD, DDS Petah-Tiqva, Israel
References 1. Fletcher GH, Jesse RH: Contribution of supervoltage roentgenotherapy to integration of radiation and surgery in head and neck squamous cell carcinomas. Cancer 15:566, 1962 2. Attie NJ, Catania A, Brenner S: Myxoma of the maxilla: Preoperative irradiation to facilitate resection. Am J Roentgen01 96: 19, 1966 3. Busche F, Galante M: Radical preoperative roentgen therapy in primary inoperable advanced cancers of the head and neck. Radiology 73:845, 1959
CURRENT LITERATURE
simulating bursae or angiomas with histiocytes and mucocytes to a dense, well-vascularized fibrous connective tissue pseudocyst. Inflammation is never conspicuous. Marsupialization inevitably leads to recurrence. Excision of the sublingual gland is required for effective managemerit.-G.H. SPERBER Reprint requests to Dr Batsakis: Division of Pathology, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Houston, TX 77030. Rheologic Predictors of the Severity of the Painful Sickle Cell Crisis. Ballas SK, et al. Blood 72:1216, 1988 There is interest in defining hematologic factors that influence the clinical severity and frequency of sickle cell crisis. This article reports a study that examined the clinical, hematologic, and rheologic characteristics of erythrocytes in 65 patients and correlated the data with severity of sickling crisis. Patients who required parenteral nar-
cotic administration or hospitalization for sickling crisis were included in the study. Precrisis hematologic and rheologic data had been obtained on the patients during an asymptomatic state. Red cell deformability index (DI) and “denseness,” and counts of irreversibly sickled cells (ISC) were determined for precrisis and crisis states. Results disclosed that a high DI correlated positively with increased severity and frequency of crisis, whereas increased denseness and ISC correlated with a milder disease course. Increased erythrocyte deformability is theorized to enhance the stickiness of the cell to endothelium and result in capillary blockage. A more dense cell is more rigid, deforms less readily, and there is decreased surface contact with the endothelium and less respective adherence. The data suggest that patients with increased numbers of dense erythrocytes and ISC will have a lower DI and therefore less frequent sickling crises and a milder course of disease.-B.B. HORSWELL Reprint requests to Dr Ballas: Cardeza Foundation, 1015Walnut St, Philadelphia, PA 19107.
Continued from page 438 To the Editor:-1 read with interest, and some surprise, the letter of disappointment sent by Dr Michael S. Freedus. I was indeed fortunate that the AAOMS had taped the session. I was able to replay it and found that my recollections coincided with what was actually said. Unfortunately, neither my memory nor the tapes coincide with the statements or attitudes attributed to me by Dr Freedus. I did not “denounce arthroscopy entirely” or even partially. I did express my opinion on disc repositioning. I was not then and am not now “disgruntled” and I neither called for nor implied the need for a “moratorium.” I did not dispute the “successes reported,” but I did call for clear definitions of “success” and further called for objective supporting data. I do not recognize the procedure as “benign and effective,” but I am willing to accept scientific proof that it is. I have great difficulty dealing with such contradictory statements in Dr Freedus’ letter as “we’re learning” and that it is “erroneous (to) claim that it is ‘experimental’. ” I certainly agree that “we ourselves have been an influencing factor in recent third party refusal to pay for the procedure,” but not for the reasons implied by Dr Freedus. I stated quite clearly in my presentation where I felt the fault lay. It is my tendency to advance knowledge by questioning. I would, therefore, pose a question to Dr Freedus. If his practice is anything like mine, he probably sees few patients not previously treated. Since everybody claims enormously high success rates, regardless of the modality used, where are all these patients coming from? My only conclusion is that this same small patient population is being moved from office to office like the proverbially uneaten Christmas fruitcake.
DAVID I. BLAUSTEIN, DDS, PHD Chicago, Illinois PROPER TREATMENT OF ODONTOGENIC MYXOMA To the Editor:-1
R. Cuestas-Carnero
should like to comment on the article by et al on odontogenic myxoma (J Oral
Maxillofac Surg 46:705, 1988). This article has a number of flaws and inaccuracies. The authors state that myxoma not only does not respond well to radiation therapy, but a serious risk of malignant transformation exists if this method of treatment is used. However, despite this wise statement, they used radiation. Using radiation for the treatment of benign tumors is not well accepted by most surgeons, and its use in such instances is usually remembered only by regrets. Radiation for vascular tumors of the skull base is among the few exceptions; but, in the last few years, specialists in the field have opposed radiotherapy even in these cases. The authors use out-of-date references for supporting their use of radiation treatment. They cite Fletcher and Jesse’ and Attie et al* from reports published in 1962 and 1966, respectively, for providing “the rationale of the preoperative use of radiation” and quote the article of Busche and Galante from 19593 without reporting that both this and the former articles referred to malignant tumors only. My review of the pertinent literature indicates that surgery is the treatment of choice for odontogenic myxoma and that radiation for the treatment of benign tumors is contraindicated in most cases. A serious risk of malignant transformation of the primary tumor, as well as the development of secondary malignant tumors, exists when benign tumors in the head and neck region are irradiated. Y. ZOHAR, MD, DDS Petah-Tiqva, Israel
References 1. Fletcher GH, Jesse RH: Contribution of supervoltage roentgenotherapy to integration of radiation and surgery in head and neck squamous cell carcinomas. Cancer 15:566, 1962 2. Attie NJ, Catania A, Brenner S: Myxoma of the maxilla: Preoperative irradiation to facilitate resection. Am J Roentgen01 96: 19, 1966 3. Busche F, Galante M: Radical preoperative roentgen therapy in primary inoperable advanced cancers of the head and neck. Radiology 73:845, 1959